Antiphospholipid Antibodies in Critically Ill Patients With COVID‐19

Xiao, Meng; Zhang, Yan; Zhang, Shulan; Qin, Xuzhen; Xia, Peng; Cao, Wei; Jiang, Wei; Chen, Huan; Ding, Xin; Zhao, Hua; Zhang, Hongmin; Wang, Chun-Yao; Zhao, Jing; Sun, Xuguo; Tian, Ran; Wu, Wei; Wu, Dong; Ma, Jie; Chen, Yu; Zhang, Dong; Xie, Jing; Yan, Xiaowei; Zhou, Xiang; Liu, Zhengyin; Wang, Jinglan; Du, Bin; Qin, Yan; Gao, Peng; Lu, Minya; Hou, Xin; Wu, Xian; Zhu, Huadong; Xu, Yingchun; Zhang, Wen; Li, Taisheng; Zhang, Fengchun; Zhao, Yongqiang; Li, Yongzhe; Zhang, Shuyang

doi:10.1002/art.41425

Cited by 156 publications

(202 citation statements)

References 18 publications

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“…Nevertheless, the pathogenicity of APL from COVID-19 patients was proven elegantly in a pre-publication by Zuo et al, in which IgG aPS/PT antibodies led to NETosis in vitro , thus contributing to thrombus formation, and increased thrombus extension in vivo in a mouse model ( 104 ). This finding is corroborated by the observation that APL occur preferably in critically ill patients ( 103 ). Altogether, the risk of thrombosis mediated by APS should be kept in mind and a prolonged aPTT should not prevent proper anticoagulation in patients.…”

Section: Rheumatic Diseases and Covid-19supporting

confidence: 69%

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

et al. 2020

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In December 2019, a cluster of severe pneumonia was observed in China, with the subsequent discovery of a new beta-coronavirus (SARS-CoV-2) as the causative agent. The elicited disease COVID-19 is characterized by fever, dry cough, myalgia, or fatigue and has a favorable outcome in the majority of cases. However, in some patients COVID-19 leads to severe pneumonia and sepsis with subsequent respiratory failure and gastrointestinal, hematological, neurological, and cardiovascular complications. A higher risk of infection is intrinsic to active rheumatic and musculoskeletal diseases (RMD) and the use of biological disease modifying anti-rheumatic drugs (DMARDs). With an increasing number of reports on COVID-19 in RMD patients, we are beginning to appraise their risks. In this review, we summarize the published cases of COVID-19 infections in RMD patients, including patients with inflammatory arthritis and connective tissue diseases as well as anti-phospholipid syndrome and Kawasaki syndrome. Overall, patients with inflammatory arthritis do not seem to be at a higher risk for infection or a severe course of COVID-19. Risk for critical COVID-19 in patients with systemic inflammatory diseases such as SLE or vasculitis might be increased, but this needs further confirmation. Furthermore, we summarize the data on DMARDs used to fight SARS-CoV-2 infection and hyperinflammation.

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Section: Rheumatic Diseases and Covid-19supporting

confidence: 69%

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

et al. 2020

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“…Interestingly, IgG/IgM anti-prothrombin and IgG/IgM anti-annexin-V data show that distribution of positive cases number increases in late infection patients, signi cantly in anti-annexin-V results, suggesting a possible role for these anti-phospholipids antibodies in disease course. In fact, it has been reported that aPLs can arise transiently in some patients with critical illness and SARS-CoV-2 infection (disappearing in a few weeks) [22]; as well as in other genetically predisposed patients they could trigger a "COVID-19-induced-APS-like-syndrome" or other autoimmune diseases [27][28]. Unfortunately, we could not perform a longer-term follow up.…”

Section: Resultsmentioning

confidence: 90%

“…Finally, despite IgA aCL and IgA aβ2GP1 are not included in the current APS classi cation criteria [30], recent evidences highlight a possible role for IgA anti-phospholipids antibodies in genetically predisposed patients [27]. Being IgA antibodies the most important immunoglobulins to counteract infectious pathogens in respiratory and digestive systems, they have an important role in mucosal immunity.…”

Section: Resultsmentioning

confidence: 99%

Anti-phospholipids antibodies and immune complexes in COVID-19 patients: a putative role in disease course for anti-annexin-V antibodies

Cristiano

Fortunati

Cherubini

et al. 2020

Preprint

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Introduction: Besides distinctive respiratory and digestive hallmarks, COVID-19 has been recently associated with a high prevalence of pro-inflammatory and hypercoagulable states known as “COVID-19 Associated Coagulopathy” (CAC), corresponding to a worsening in patients’ conditions, whose causes are still to be elucidated. A link between anti-phospholipids antibodies (aPLs) and viral infections has long been suggested. APLs are assessed for Anti-phospholipid Syndrome (APS) diagnosis, characterized by thrombocytopenia, thrombosis and coagulopathy. Furthermore, circulating immune complexes (CICs), arisen upon inflammatory responses and related immune dysregulation, can lead to endothelial cells damage and thrombotic complications.Method: We performed an extended panel including IgG/IgM anti-cardiolipin, IgG/IgM anti-β2-glycoprotein-1, coupled with IgG/IgM anti-prothrombin, IgG/IgM anti-annexin-V on two COVID-19 patient groups (early and late infection time) and a negative control group. IgG CICs analysis followed to evaluate inflammatory status, through a possible complement system activation.Results: Our results showed low positive cases percentage in IgG/IgM anti-cardiolipin and IgG/IgM anti-β2-glycoprotein-1 assays (4.54%, 6.25%, 4.55%; in early infection group, late infection group and control group, respectively); few positive cases in IgG/IgM anti-prothrombin and IgG/IgM anti-annexin-V immunoassays; no IgG CICs positivity in any patient.Conclusions: In conclusion, our data show a low aPLs prevalence, likely excluding an involvement in the pathogenesis of CAC.Interestingly, IgG/IgM anti-prothrombin and anti-annexin-V positive cases, detected in late infection group, suggest that aPLs could temporarily increase or could trigger a “COVID-19-induced-APS-like-syndrome” in predisposed patients.Finally, even though aPLs are transient, they may still have a thrombotic potential in genetically predisposed COVID-19 patients.

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“…90 A study from a Wuhan hospital found that, of the 66 patients who were critically ill due to Covid19, 47% had positive antiphospholipid antibodies and that patients who had more than one, where the value of at least one was >40 CU, had an increased risk of cerebral infarction (p 0.023). 91 Other cases are reported of pulmonary emboli, ischaemic strokes, limb and digital ischaemia and deep vein thromboses in patients with positive antiphospholipid antibodies. 85,[92][93][94][95] A French study of 150 patients on an intensive care unit due to COVID-19 related ARDS found that 64/150 had clinically significant thrombotic events during ICU stay.…”

Section: Anti-phospholipid Syndrome and Covid-19mentioning

confidence: 99%

Clinical management of Lupus patients during the COVID-19 pandemic

Mason

Rose

Edwards

2020

Lupus

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Severe acute respiratory syndrome coronavirus (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Historical evidence suggests that Lupus patients have a higher incidence of several viral infections. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. In this context there has been concern that Lupus patients may be at a higher risk of developing COVID-19 and suffering a severe disease course. As a result, many Lupus patients have been advised to ‘shield’ by isolating from social contact in the hope that this will reduce the likelihood of infection. Early clinical data does not appear to show that the incidence of COVID-19 is higher in Lupus patients. Reassuringly, the clinical course of COVID-19 in Lupus does not generally seem to be more severe than in the general population. There has been huge interest in repurposing existing drugs as potential treatments, including several used to treat Lupus. Of these, corticosteroids and hydroxychloroquine are the most well researched so far. The current evidence suggests that the corticosteroid dexamethasone improves outcome for the sickest COVID-19 patients requiring respiratory support. Initial reports suggested that hydroxychloroquine could have a positive impact on the course of COVID-19, however larger prospective studies have not supported this. Janus kinase inhibitors, currently being investigated for efficacy in lupus, have been shown to have anti-viral effects in vitro and inhibiting the JAK-STAT pathway may dampen down the host hyper-inflammatory response. Several trials are ongoing to assess the outcome of the use of JAK inhibitors in COVID-19 positive patients. For most patients continuing with their existing therapies to prevent a lupus flare or adverse events associated with sudden corticosteroid withdrawal is important whilst an Individualised risk assessment remains vital.

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Antiphospholipid Antibodies in Critically Ill Patients With COVID‐19

Cited by 156 publications

References 18 publications

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

Anti-phospholipids antibodies and immune complexes in COVID-19 patients: a putative role in disease course for anti-annexin-V antibodies

Clinical management of Lupus patients during the COVID-19 pandemic

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